Yes
| TX | 094148602 | 1093744187 |
| LA | 1731242 | 1093744187 |
Baptist Hospitals of Southeast Texas
3080 College Street
Beaumont, TX 77701
| DSH450346A | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Baptist Beaumont Hospital Outpatient Cancer Infusion Clinic | 3555 Stagg Drive | Beaumont | TX | Active |
| DSH450346B | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Baptist Beaumont Hospital Outpatient Infusion Clinic | 3070 College Street | Beaumont | TX | Active |
| DSH450346C | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | BAPTIST BEAUMONT HOSPITAL-Behavioral Health | 3250 FANNIN ST | BEAUMONT | TX | Active |
| DSH450346D | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Orange / Radiology | 608 Strickland Dr | Orange | TX | Active |
| DSH450346E | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Orange / Emergency Room | 608 Strickland Dr | Orange | TX | Terminated |
| DSH450346F | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Orange / Outpatient Infusion | 608 Strickland Dr | Orange | TX | Active |
| DSH450346G | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Wound Healing Center / Wound Care Clinic | 810 Hospital Drive Suite 200 | Beaumont | TX | Active |
| DSH450346H | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Smart Health Clinic | 3282 College St. | Beaumont | TX | Active |
| DSH450346J | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | CANCER CENTER OF SOUTHEAST TEXAS | 8333 9TH AVENUE | PORT ARTHUR | TX | Active |
| DSH450346K | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | ALTUS CANCER CENTER - Hematology | 310 N 11TH ST | BEAUMONT | TX | Active |
| DSH450346L | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Outpatient Infusion - Woodville - Infusion | 1100 W. Bluff St. | Woodville | TX | Terminated |
| DSH450346M | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Wound Care Center- Orange - Wound Healing Center | 608 Strickland Drive | Orange | TX | Active |
| DSH450346N | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | RADIOLOGY ONCOLOGY ALTUS - Radiology Oncology | 310 N 11th Street | Beaumont | TX | Active |
| DSH450346P | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Radiation Oncology- Port Arthur - Radiology Oncology | 8333 9TH Avenue | Port Arthur | TX | Active |
| DSH450346Q | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Jasper Outpatient Infusion - Outpatient Infusion Clinic | 1440 FM 777 | Jasper | TX | Active |
| DSH450346R | Child | DSH | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | Lumberton Infusion Clinic - Outpatient Infusion Clinic | 114 South LHS Drive | Lumberton | TX | Active |
| Details | Last Recertification Date | Update | Recertification | | 8/21/2024 12:27:49 PM | 8/21/2024 12:27 PM |
| Details | State | Update | | Approved | Active | 4/1/2024 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Chandler, Bryan
Chief Operations Officer
Baptist Hospitals of Southeast Texas
4092125004 | 3/6/2024 7:32 AM |
| Details | 340B ID | Update | New Registration | | DSH450346Q | 3/6/2024 7:32 AM |
| Details | Entity Name | Update | New Registration | BAPTIST BEAUMONT HOSPITAL | BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL | 3/6/2024 7:32 AM |
| Details | Entity Subname | Update | New Registration | Jasper Outpatient Infusion | Jasper Outpatient Infusion - Outpatient Infusion Clinic | 3/6/2024 7:32 AM |
| Dates | Participating Approval Date | Update | New Registration | | 3/6/2024 7:32:08 AM | 3/6/2024 7:32 AM |
| Details | State | Update | New Registration | Pending | Approved | 3/6/2024 7:32 AM |
| Dates | Signed By Date | Update | New Registration | | 1/12/2024 10:26:45 AM | 3/6/2024 7:32 AM |
| Dates | Start Date | Update | New Registration | | 4/1/2024 12:00:00 AM | 3/6/2024 7:32 AM |
| Addresses | Main Address | Insert | New Registration | |
1440 FM 777
Jasper, TX 75951 | 1/11/2024 10:08 AM |
| Addresses | Billing Address | Insert | New Registration | | Baptist Hospitals of Southeast Texas
P.O. Box 1591
Beaumont, TX 77704 | 1/11/2024 10:08 AM |
| Addresses | Shipping Address | Insert | New Registration | | Baptist Hospitals of Southeast Texas
3080 College Street
Beaumont, TX 77701 | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 094148602 | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | TX | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1731242 | 1/11/2024 10:08 AM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | LA | 1/11/2024 10:08 AM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1093744187 | 1/11/2024 10:08 AM |
| Medicaid Billing | NPI: State | Insert | New Registration | | TX | 1/11/2024 10:08 AM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1093744187 | 1/11/2024 10:08 AM |
| Medicaid Billing | NPI: State | Insert | New Registration | | LA | 1/11/2024 10:08 AM |
| Contacts | Primary Contact | Insert | New Registration | | Powell, Aily
Administrative Director of Pharmacy
Baptist Hospitals of Southeast Texas
4092127282 | 1/11/2024 10:08 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Chandler, Bryan
Chief Operations Officer
Baptist Hospitals of Southeast Texas
4092125004 | 1/11/2024 10:08 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Grant Number | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | 340B ID | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Medicare Provider Number | Insert | New Registration | | 450346 | 1/11/2024 10:08 AM |
| Details | Entity Name | Insert | New Registration | | BAPTIST BEAUMONT HOSPITAL | 1/11/2024 10:08 AM |
| Details | NOFO Number | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | Program Code | Insert | New Registration | | DSH | 1/11/2024 10:08 AM |
| Details | Entity Subname | Insert | New Registration | | Jasper Outpatient Infusion | 1/11/2024 10:08 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Details | State | Insert | New Registration | | Pending | 1/11/2024 10:08 AM |
| Dates | Registration Date | Insert | New Registration | | 1/11/2024 10:08:17 AM | 1/11/2024 10:08 AM |
| Dates | Signed By Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Dates | Start Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Terminations | Termination Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 1/11/2024 10:08 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 1/11/2024 10:08 AM |